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Fundamentals of Rectal Cancer SurgeryFundamentals of Rectal Cancer Surgery

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Inferior Mesenteric Vein (IMV)

Inferior Mesenteric Vein (IMV) is a topic covered in the Fundamentals of Rectal Cancer Surgery.

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High ligation and division of the inferior mesenteric vein near the inferior border of the pancreas are essential for a low anastomosis with total mesorectal excision (TME)[1] (Figure 3.1). As the entire sigmoid colon is commonly resected, high ligation of the inferior mesenteric vein (IMV) will provide the colon an additional 10 cm of reach into the pelvis.[2] Many minimally invasive surgeons prefer to initiate their medial to lateral dissection in this area in an effort to arrive at the inferior mesenteric artery in the proper plane on Gerota’s fascia. By sweeping the small bowel to the patient’s right, which laparoscopically can be accomplished with the patient in steep Trendelenburg, airplaned right side down, the duodenojejunal junction is easily identified.[3] By lifting the mesentery of the descending colon, a taut band can be generally identified running just lateral to the duodenojejunal junction, parallel to the aorta. This maneuver allows for easy identification of the inferior mesenteric vein. The plane of dissection is immediately anterior to Gerota’s fascia and is entered by putting the IMV on tension and dissecting under the vessel. The splanchnic and hypogastric nerve plexus can be swept posterior to vein, and if this plane is followed caudally, it will lead to the inferior mesenteric artery. The IMV is transected below the lower border of the pancreas. It is wise to leave a 1 cm stump inferior to the pancreas for transection of the IMV so that any resultant bleeding is easily controlled. The IMV is again transected distal as it comes into the region of the inferior mesenteric artery (IMA) at the takeoff of the left colic vessel.

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High ligation and division of the inferior mesenteric vein near the inferior border of the pancreas are essential for a low anastomosis with total mesorectal excision (TME)[1] (Figure 3.1). As the entire sigmoid colon is commonly resected, high ligation of the inferior mesenteric vein (IMV) will provide the colon an additional 10 cm of reach into the pelvis.[2] Many minimally invasive surgeons prefer to initiate their medial to lateral dissection in this area in an effort to arrive at the inferior mesenteric artery in the proper plane on Gerota’s fascia. By sweeping the small bowel to the patient’s right, which laparoscopically can be accomplished with the patient in steep Trendelenburg, airplaned right side down, the duodenojejunal junction is easily identified.[3] By lifting the mesentery of the descending colon, a taut band can be generally identified running just lateral to the duodenojejunal junction, parallel to the aorta. This maneuver allows for easy identification of the inferior mesenteric vein. The plane of dissection is immediately anterior to Gerota’s fascia and is entered by putting the IMV on tension and dissecting under the vessel. The splanchnic and hypogastric nerve plexus can be swept posterior to vein, and if this plane is followed caudally, it will lead to the inferior mesenteric artery. The IMV is transected below the lower border of the pancreas. It is wise to leave a 1 cm stump inferior to the pancreas for transection of the IMV so that any resultant bleeding is easily controlled. The IMV is again transected distal as it comes into the region of the inferior mesenteric artery (IMA) at the takeoff of the left colic vessel.

Vimeo video.

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Last updated: November 22, 2021

Citation

"Inferior Mesenteric Vein (IMV)." Fundamentals of Rectal Cancer Surgery, 2021. ASCRS U, www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831013/all/Inferior Mesenteric Vein (IMV).
Inferior Mesenteric Vein (IMV). Fundamentals of Rectal Cancer Surgery. 2021. https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831013/all/Inferior Mesenteric Vein (IMV). Accessed March 21, 2023.
Inferior Mesenteric Vein (IMV). (2021). In Fundamentals of Rectal Cancer Surgery https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831013/all/Inferior Mesenteric Vein (IMV)
Inferior Mesenteric Vein (IMV) [Internet]. In: Fundamentals of Rectal Cancer Surgery. ; 2021. [cited 2023 March 21]. Available from: https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831013/all/Inferior Mesenteric Vein (IMV).
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Inferior Mesenteric Vein (IMV) ID - 2831013 Y1 - 2021/11/22/ BT - Fundamentals of Rectal Cancer Surgery UR - https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831013/all/Inferior Mesenteric Vein (IMV) DB - ASCRS U DP - Unbound Medicine ER -
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Grapherence® [↑3]
    • Fundamentals of Rectal Cancer Surgery
    • Background
    • Rectal Anatomy
    • Rectal Cancer Biology and Hereditary Cancer Syndromes
    • Rationale for Multi-Modality Therapy
    • Preoperative Issues
    • Preoperative Staging
    • Role of Tumor Board
    • Indications for Preoperative Neoadjuvant Therapy
    • Local Excision
    • Indications for LAR Versus Intersphincteric Resection Versus APR
    • Indications for Extended Resection
    • Preoperative Preparation
    • Interoperative
    • Patient Positioning and Equipment for Rectal Cancer Surgery
    • Inferior Mesenteric Artery
    • Inferior Mesenteric Vein (IMV)
    • Splenic Flexure Mobilization
    • Surgical Techniques for Length
    • Technique of Total Mesorectal Excision (TME)
    • Tailored Mesorectal Excision (TME)
    • Bowel Transection and Anastomosis
    • Indications for Fecal Diversion
    • Abdominoperineal Resection
    • Standardized Operative Report
    • Management of Intraoperative Vascular and Urinary Complications
    • Postoperative Issues
    • Rectal Cancer Pathology Assessment
    • Adjuvant Therapy for Rectal Adenocarcinoma
    • Surveillance After Rectal Cancer Treatment
    • Management of Local Recurrences
    • Short-Term Complications - Anastomotic
    • Short-Term Complications - Urinary
    • Ostomy Complications and Management
    • Long-Term Complications – Bowel Dysfunction
    • Long-Term Complications - Sexual Dysfunction and Its Management
    • Parastomal and Perineal Hernias
    • Impact of Postoperative Complications On Oncologic Outcomes
    • Course Complete
    • Final Assessment
Grapherence® [↑3]
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  • Anastomotic Construction
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  • Colon Cancer Surgical Treatment: Principles of Colectomy
  • Open Left Hemicolectomy for Proximal Sigmoid Cancer
  • Robotic Low Anterior Resection
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